Phill.com Sports DocPOSTED: Thursday, August 15, 2013, 6:00 AM Justin Shaginaw, MPT, ATC, Aria 3B Orthopaedic Institute, Athletic Trainer - US Soccer FederationGatorade, Powerade, Accelerade, Lucozade, Sqwincher, EFS, Recharge, All Sport, Levelen… as you can see there are endless sports drinks on the market. These drinks say they can increase performance, decrease cramping, and speed recovery. What does the research say? Pre-activity sports drinksThere are numerous pre-activity sports drinks on the market that claim they improve performance through numerous methods including increased energy, maintaining hydration, and adding to carbohydrate stores. Let’s look at the main components, (caffeine, carbohydrates) and see what the research shows.CaffeineWe all know how that our morning cup of coffee helps start the day off on the right foot. But does it help to run faster or cycle longer? A 2012 article in the Journal of Strength & Conditioning Research showed “that acute ingestion of a caffeine-containing energy drink can enhance resistance exercise performance to failure and positively enhance psychophysiological factors related to exertion in trained men.”There are numerous articles that support the use of caffeine performance enhancing supplement. Keep in mind that more is not better when it comes to caffeine and there can be negative side effects of excessive caffeine consumption. So please speak with your physician or a nutritionist about how much caffeine is safe and effective. And for NCAA athletes please consult your school’s athletic trainer as you can test positive if you’re over a certain limit.CarbohydratesCarbohydrates are thought to have a role in pre-, during, and post-exercise performance and recovery. Pre-activity carbohydrates are thought to top off one’s energy stores. A study in the Journal of Strength and Conditioning Research in 2013 showed that pre-activity “sports drinks allow higher stroke frequency during play, with decreased rates of perceived exertion” in tennis players.What we don’t know is what is the optimal amount of carbohydrates and where do we get them from. Is there one drink that’s better than another or can we just get them from a healthy pre-activity snack? There is also concern for how an athlete feels eating and drinking prior to activity. Will it make them feel bloated? Can they tolerate a sports drink but not an energy bar? The general guideline is to have some form of carbohydrates pre-activity that your GI system can tolerate well.During Activity DrinksThese can be broken down into two categories: energy replacement through carbohydrates and electrolyte replacement to limit cramping and dehydration.CarbohydratesCarbohydrates during activity are thought to supplement the body’s energy stores helping to maintain performance levels over longer periods of exercise. A 2011 article in the Journal of Sports Sciences recommends “Carbohydrate intake during exercise should be scaled according to the characteristics of the event. During sustained high-intensity sports lasting about 1 hour, small amounts of carbohydrate, including even mouth-rinsing, enhance performance via central nervous system effects. While 30-60 grams per hour is an appropriate target for sports of longer duration, events greater than 2.5 hours may benefit from higher intakes of up to 90 grams per hour.” Once again, the type and amount of carbohydrates is still unknown with recommendations of what the athlete tolerates from a GI perspective being most important.ElectrolytesWhat causes cramping in athletes? Is it dehydration, sodium loss, or something else? An article in the British Journal of Sports Medicine 2013 states “Significant and serious hypohydration (dehydration) with moderate electrolyte losses does not alter cramp susceptibility when fatigue and exercise intensity are controlled. Neuromuscular control may be more important in the onset of muscle cramps than dehydration or electrolyte losses.”For cramping, the majority of sports drinks are isotonic or hypotonic meaning they have the same or fewer electrolytes than what is in your body normally. So not only do these drinks not replace lost electrolytes but they can pull electrolytes out of the body. Exceptions to this are sports drinks like Levelen that are based off of sweat testing and replace specific electrolytes lost by the individual.So what’s the bottom line? For the average athlete who is working out for 60 minutes or less water is just fine. If it’s greater than 60 minutes or in a hot and humid environment, a sports drink comprising of both carbohydrates and electrolytes may be beneficial. Otherwise, these sports drinks tend to be nothing more than empty calories.Post-activity DrinksPost activities drinks are comprised mainly of carbohydrates and protein. The goal is to replenish what is lost immediately post-exercise. It is assumed that this helps in recovery. However, two studies dispute this common thought process.A 2006 study in the Journal of Sports Medicine and Physical Fitness showed that “supplementation with a sports drink during recovery showed a significant short-term subjective positive effect compared with placebo. However, no effects were seen on physical performance or signs of overtraining.”Another study in International Journal of Sport Nutrition and Exercise Metabolism 2008 concluded that ”consuming a carbohydrate + protein or carbohydrate beverage immediately after novel eccentric exercise failed to enhance recovery of exercise-induced muscle injury differently than what was observed with a placebo drink.” What we thought was common knowledge regarding carbohydrate replacement post exercise may not be backed up by science.ConclusionsPre-activity, caffeine can have positive benefit and one should have some sort of carbohydrates 30-60 minutes before activity. During activity, most people are fine with just water unless you’re competing for greater than 60 minutes, are in a hot and humid environment, or are prone to cramping. Lastly, for post-activity recovery you can probably skip the protein drink and just head home for a healthy well balanced meal.